The pericardium is a multi-layer membranous fibro serous sac that surrounds the heart. An inner layer of the pericardium, known as the serous pericardium, is adjacent to the outer layer of the heart, also known as the epicardium. An outer layer of the pericardium is known as the fibrous pericardium. Between the fibrous pericardium and serous pericardium is a space known as the pericardial space. The term “pericardium” is often used, however, to refer only to the fibrous pericardium. Similarly, the term “pericardial space” is often used to refer generally to the space between the fibrous pericardium and the heart.
Certain surgical or other procedures on the heart require access to the pericardial space through the pericardium. Known approaches for accessing the pericardium and heart from outside the body include sternotomy and sub-xyphoid approaches. One such surgical procedure that requires access to the pericardial space is the delivery of cardiac support devices. Cardiac support devices are structures, sometimes referred to as jackets, that surround all or portions of a diseased heart. These devices are intended to treat chronic heart failure or other cardiac disease, which may be associated valvular dysfunction, by constraining expansion of the heart. They can be delivered and implanted using conventional cardiothoracic surgical techniques or minimally invasive surgical procedures. Devices of these types and associated delivery tools and methods are shown, for example, in the following U.S. patents, all of which are incorporated herein by reference in their entirety.
Inventor NamePatent/Publication No.Alferness5,702,343Alferness et al.6,123,662Vanden Hoek et al.6,293,906Alferness et al.6,482,146Lau et al.6,702,732Walsh et al.6,902,522Girard et al.6,951,534
Tools and methods for accessing the pericardial space and for introducing other instruments and therapeutic devices such as cardiac support devices into that space are also known. Examples of tools and methods of these types are shown in the following U.S. patents and published applications, all of which are incorporated herein by reference in their entirety.
Inventor NamePatent/Publication No.Grabek5,931,810Schmidt5,972,013Schmidt et al.6,206,004Lau et al.2005/0055032Lau et al.2005/0102010
Cardiac support devices of the type described above are typically delivered through an incision in the pericardium near the apex of the heart. Visualizing the heart and mounting the devices through the incision can involve moving the incision and manipulating the pericardium. In the course of these procedures the pericardium can sometimes interfere with the delivery of the device.
There is, therefore, a continuing need for improved devices and methods for managing the pericardium during intra-pericardial procedures. Devices and methods that can enhance cardiac support device delivery procedures would be especially desirable.